NPI | 1811967748 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C162697) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 209337) |
Enumeration Date | 2006-01-24 |
Last Update Date | 2024-04-25 |